umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Teenager fatalities: epidemiology and implications for prevention
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide.

The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures.

A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy.

In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide.

Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved.

Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation.

The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention.

This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2010. , 56 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1371
Keyword [en]
Teenager, fatalities, injury, suicide, alcohol, drugs, intoxication, trends
National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
URN: urn:nbn:se:umu:diva-36682ISBN: 978-91-7459-063-0 (print)OAI: oai:DiVA.org:umu-36682DiVA: diva2:355629
Public defence
2010-10-29, Betula, by 6M, Umeå, 15:05 (Swedish)
Opponent
Supervisors
Available from: 2010-10-11 Created: 2010-10-07 Last updated: 2012-10-09Bibliographically approved
List of papers
1. A survey of teenager unnatural deaths in northern Sweden 1981-2000
Open this publication in new window or tab >>A survey of teenager unnatural deaths in northern Sweden 1981-2000
2005 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 37, no 2, 253-258 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

Keyword
Adolescent, Age Distribution, Cause of Death, Female, Humans, Incidence, Male, Poisson Distribution, Regression Analysis, Sex Distribution, Suicide/prevention & control/statistics & numerical data, Sweden/epidemiology, Wounds and Injuries/*mortality/prevention & control
Identifiers
urn:nbn:se:umu:diva-12798 (URN)10.1016/j.aap.2004.09.002 (DOI)15667811 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2013-10-14Bibliographically approved
2. Teenage suicides in northern Sweden: an interview study of investigating police officers
Open this publication in new window or tab >>Teenage suicides in northern Sweden: an interview study of investigating police officers
2000 (English)In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 6, no 2, 115-119 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To disclose recurrent, dynamic, and static factors in teenage suicide involving the suicidee, his/her family, and the community; and to investigate the feasibility of using police as informants for suicide studies.

SUBJECTS: All deaths categorised as suicide 1993 through 1995 among teenagers in Northern Sweden (n=15).

METHOD: Semiqualitative interviews with police officers, and, when applicable, general practitioners. Police reports, necropsy protocols, medical records, and conscription data were also analysed.

RESULTS: Most suicides occurred in rural and depopulated areas. In contrast to males, females often had a history of overt psychiatric problems with suicide attempts. At least two thirds of the suicides were planned.

CONCLUSION: Cultural and sociopolitical aspects are important in teenage suicide as well as gender differences. Police officers can provide essential information. Identifying teenagers at risk remains difficult, however, due to low baseline rates.

National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-36681 (URN)10.1136/ip.6.2.115 (DOI)10875667 (PubMedID)
Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12Bibliographically approved
3. In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members
Open this publication in new window or tab >>In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members
2008 (English)In: BMC Psychiatry, ISSN 1471-244X, Vol. 8, no 1, 26- p.Article in journal (Refereed) Published
Abstract [en]

Background Studies of family reactions following teenage suicide are hampered by the psychological difficulties of approaching families and recruiting an unbiased sample of study subjects. By using a small but consecutive series of cases, we examined the qualitative aspects of loosing a teenage family member due to suicide. Such an understanding is important for future organisation of proper programs that provide professional support in the grief process.

Methods From a large project on teenage unnatural death in northern Sweden 1981-2000 (n=88), 13 cases from 1995 through 1998 were retrospectively identified and consecutively analysed. Ten families agreed to participate. The open interviews took place 15 to 25 months after the suicide. The information gathered was manually analysed according to a grounded theory model, resulting in allocation of data into one of three domains: post-suicidal reactions, impact on daily living, and families´need for support.

Results. Teenager suicide is a devastating trauma for the surviving family and the lacko of sustainable explanations for the suicide is a predominant issue in the grief process. The prolonged social and psychological isolation of the families in grief should be challenged. At the time of the interview, the families were still struggling with explaining why the suicide occurred, especially since most suicides had occurred without overt premonitory signs. The bereaved family members were still profoundly affected by the loss, but all had returned to an ostensibly normal life. Post-suicide support was often badly timed and insufficient, especially for younger siblings.

Conclusions Family doctors can organise a long-term, individually formulated support scheme for the bereaved, including laymen who can play a most significant role in the grief process. There is also a need for better understanding of the families who have lost a teenager whom committed suicide and for the development and testing of treatment schemes for the bereaved family.

Keyword
teenage suicide, surviving family members
National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-9559 (URN)10.1186/1471-244X-8-26 (DOI)18426560 (PubMedID)
Available from: 2008-04-25 Created: 2008-04-25 Last updated: 2013-10-14Bibliographically approved
4. Teenage suicide cluster formation and contagion: implications for primary care
Open this publication in new window or tab >>Teenage suicide cluster formation and contagion: implications for primary care
2006 (English)In: BMC Family Practice, ISSN 1471-2296, Vol. 17, no 7, 32- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We have previously studied unintentional as well as intentional injury deaths among teenagers living in the four northernmost counties, forming approximately 55% of Sweden with 908,000 inhabitants in 1991. During this work, we found what we suspected to be a suicide cluster among teenagers and we also suspected contagion since there were links between these cases. In this present study, we investigate the occurrence of suicide clustering among teenagers, analyze cluster definitions, and suggest preventive measures. METHODS: A retrospective study of teenager suicides autopsied at the Department of Forensic Medicine in Umea, Sweden, during 1981 through 2000. Police reports, autopsy protocols, and medical records were studied in all cases, and the police officers that conducted the investigation at the scene were interviewed in all cluster cases. Parents of the suicide victims of the first cluster were also interviewed. Two aggregations of teenager suicides were detected and evaluated as possible suicide clusters using the US Centers for Disease Control definition of a suicide cluster. RESULTS: Two clusters including six teenagers were confirmed, and contagion was established within each cluster. CONCLUSION: The general practitioner is identified as a key person in the aftermath of a teenage suicide since the general practitioner often meet the family, friends of the deceased, and other acquaintances early in the process after a suicide. This makes the general practitioner suitable to initiate contacts with others involved in the well-being of the young, in order to prevent suicide cluster formation and para-suicidal activities.

National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-12797 (URN)10.1186/1471-2296-7-32 (DOI)16707009 (PubMedID)
Available from: 2007-04-19 Created: 2007-04-19 Last updated: 2013-10-14Bibliographically approved
5. ER visits predict premature death among teenagers
Open this publication in new window or tab >>ER visits predict premature death among teenagers
2012 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 48, no S1, 397-400 p.Article in journal (Refereed) Published
Abstract [en]

Background: The purpose of this study was to investigate if teenagers visiting an emergency room because of injury have an increased risk of premature death ahead and, if so, identify possible risk factors and suggest preventive measures. Methods: In January 2010, the personal identity numbers of 12,812 teenagers who had visited the emergency room at the University Hospital in Umea. Sweden, during 1993 through 2006 because of injury were checked against the National Cause of Death Register in Sweden. Standardised mortality ratio and confidence intervals were calculated. For the unnatural deaths that took place in Sweden, the police report, autopsy protocol, and hospital records, if present, were studied. Results: Thirty-eight fatalities were included giving a standardised mortality ratio of 1.44 (95% CI: 1.02-1.98). A majority of the decedents were males (n = 32, 84%) and the median age at the time of death was 21 years. Twenty-three deaths were caused by unintentional injuries and ten by intentional injuries (all suicides), while five deaths were categorised as undetermined whether intentional or not. Seventy-four percent tested positive for either alcohol or drugs or a combination at the post mortem examination. Nine males and one female committed suicide, five tested positive for alcohol (one also for drugs), while four tested negative at the post mortem examination. One died abroad and in this case we lack information on alcohol and drugs. Conclusion: Teenagers visiting an emergency room due to injury experience an increased risk of premature death by unnatural cause and those at risk are especially males. The use of alcohol and drugs often seems to contribute to their untimely deaths. Identifying those at risk when they visit the emergency room for an injury and to take preventive actions at this stage could be a way to reduce the number of fatalities. (C) 2012 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Oxford: Elsevier, 2012
Keyword
ER, Premature death, Alcohol/drugs
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-60058 (URN)10.1016/j.aap.2012.02.012 (DOI)000307140500045 ()
Available from: 2012-10-09 Created: 2012-10-01 Last updated: 2017-12-07Bibliographically approved

Open Access in DiVA

fulltext(232 kB)1216 downloads
File information
File name FULLTEXT02.pdfFile size 232 kBChecksum SHA-512
7e0387050a6c4224cf9307899f732c14554f6ce882ff52e8217f443dda37e0150a3dbdde516841c6eb71dd75087d3a8f38a76b091e702499d8ee2c60633a99d7
Type fulltextMimetype application/pdf

Authority records BETA

Johansson, Lars

Search in DiVA

By author/editor
Johansson, Lars
By organisation
Forensic Medicine
Forensic Science

Search outside of DiVA

GoogleGoogle Scholar
Total: 1216 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1073 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf